The following persons are eligible to be enrolled in TRS-ActiveCare under terms, conditions and limitations established by the trustee unless expelled from the program under provisions of Chapter 1579, Insurance Code:

1. (1) A full-time employee as defined in §41.33 of this title (relating to Definitions Applicable to the Texas School Employees Uniform Group Health Coverage Program).
2. (2) A part-time employee as defined in §41.33 of this title (relating to Definitions Applicable to the Texas School Employees Uniform Group Health Coverage Program).
3. (3) Dependents, as defined in §41.33 of this title pursuant to §1579.004, Insurance Code. A child defined in §1579.004(3), Insurance Code, who is 25 years of age or older, is eligible for coverage only if, and only for so long as, such child's mental retardation or physical incapacity is a medically determinable condition that prevents the child from engaging in self-sustaining employment as determined by TRS.
4. (4) Individuals employed or formerly employed by a participating entity, and their dependents, who are eligible for, or participating in, continuation coverage under the Consolidated Omnibus Budget Reconciliation Act of 1985 (Pub. L. 99-272), through a group health benefit plan sponsored by the individual's employer on the first day that employer becomes a participating entity if such individuals or their dependents would have met the requirements for eligibility in paragraphs (1), (2), or (3) of this section on the individual's last day of employment with the participating entity. Notwithstanding the foregoing, the individual is eligible to participate in TRS-ActiveCare only for the duration of the individual's eligibility for COBRA continuation coverage.
5. (5) An individual who qualifies for coverage pursuant to §41.38(b) of this title (relating to Termination Date of Coverage), and their dependents.
6. (6) Full-time or part-time employees as defined in §41.33 of this title (relating to Definitions Applicable to the Texas School Employees Uniform Group Health Coverage Program) and their eligible dependents may participate in an approved HMO if they reside, live, or work in the approved service area of the HMO and are otherwise eligible to participate in the HMO under the terms of the TRS contract with the HMO.
7. (7) Individuals who become eligible as determined by TRS for continuation coverage under the Consolidated Omnibus Budget Reconciliation Act of 1985 (Pub. L. No. 99-272), through their participation in TRS-ActiveCare.

8. (8) Except as provided in the exceptions found in subparagraphs (A) - (C) of this paragraph, individuals who become eligible for coverage under the special enrollment provisions of the Health Insurance Portability and Accountability Act of 1996 (Pub. L. No. 104-191, 110 Stat. 1936 (1996)).

   1. (A) In no event may an individual who is already enrolled in TRS-ActiveCare elect a different plan, for himself or any eligible dependents, for the remainder of the existing plan year but may only add eligible dependents for coverage under the individual's existing plan selection upon the occurrence of a special enrollment event.
   2. (B) In no event may an eligible employee enroll in TRS-ActiveCare as a result of a special enrollment event applicable to his dependent.
   3. (C) In no event, as a result of a special enrollment event applicable to the dependent, may the dependent of an eligible employee enroll in TRS-ActiveCare if the eligible employee is not enrolled in TRS-ActiveCare.
9. (9) Any other individuals who are required to be covered under applicable law.

Source Note:The provisions of this §41.34 adopted to be effective August 26, 2002, 27 TexReg 7970; amended to be effective January 28, 2003, 28 TexReg 743; amended to be effective October 27, 2003, 28 TexReg 9289; amended to be effective March 8, 2007, 32 TexReg 1092; amended to be effective April 9, 2008, 33 TexReg 2825.